Government Billing Specialist

Department: Revenue Cycle

Job Title: Government Billing Specialist

Reports To: Revenue Cycle

Job Summary:

As a Government Billing Specialist at Cayuga Medical Center, you are responsible for compliant billing and collection of government claims, including but not limited to, Medicare A, Medicare B, Medicaid, Tricare and Veterans Administration. Your attention to detail is critical in order to resolve edits, gather and secure all information needed for billing, follow up, and payment of accounts in accordance with the specific payer guidelines, policies, procedures, and compliance regulations for Medicare-Medicaid. This includes responding to Additional Documentation Requests (ADRs), resolving claim rejections, packaging claims, including global billing with attachments of professional fee claims, performing proactive follow up with payers and other entities and securing payment of accounts. You must be highly methodical, focused, and make effective use of your time to achieve your daily performance goals. Successful Government Billing Specialists have strong computer skills, are comfortable with medical terminology, are organized and thrive in a highly structured environment. Members of the Revenue Cycle team work independently but are flexible and collaborate to ensure that the department's goals are met.

Job Responsibilities:

• 3-5 years of billing and collections in an acute care setting.
• Must have thorough knowledge of Medicare and Medicaid billing and reimbursement regulations.
• Perform accurate, compliant and timely billing to ensure prompt payment.
• Excellent organizational skills, attention to detail, and accountability.
• Able to handle multiple priorities; possess strong communication skills and work well in a high-pressure environment,
• Strong working knowledge of Excel, Word, Outlook, and billing/eligibility software solutions, such as Assurance.
• Completes all payer specific edits identified through the billing system.
• Resolves issues associated with incomplete claims including follow up of non-transmitted claims.
• Submit adjustment claims to Medicare/Medicaid through use of online systems.
• Attaches appropriate documents when billing manual claims including ER reports, itemized bills, implant invoices and other medical records
• Consistently meets quality standards set by Revenue Cycle.
• Meets departmental goals regarding quality and productivity.
• Maintains flexibility in work schedule availability that allows department to change/modify work schedule to meet departmental needs.
• Meets federal, state and hospital requirements related to compliance issues.
• Attends and participates in department staff meetings and attends other meetings as assigned
• Other job-specific duties as assigned

Education Requirements:

High School Diploma/GED

Preferred - Associates Degree or Certified Coder

Experience:

• Three (3) to five (5) years of healthcare billing experience.
• Experience using Microsoft Office suite including Word and Excel.
• A minimum of one (1) year minimum experience in data processing, hospital registration, insurance verification, insurance pre-certification / authorization with a healthcare provider or insurance company required

Physical Requirements:

Lifting up to 20 pounds, standing or sitting for extended periods of time, as well as repetitive use of hands and fingers.